Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 46TA09065400 | NJ |
NPI | 1003016973 |
---|---|
Provider Name | Natalya St. Kostyuk |
First Address | Monroe Twp, NJ 08832 |
Second Address | Monroe Twp, NJ 08831-6692 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2007 |
Last Update Date | 19/07/2007 |